How Are States Using Telemedicine to Tackle the Opioid Abuse Crisis?

There are pluses and minuses,” Michael Botticelli, executive director of Boston Medical Center’s newly launched Grayken Center for Addiction Medicine, said during a panel session at last October’s Connected Health Conference in Boston.In an interview with mHealthIntelligence.com last fall, Lisa Schmitz Mazur, an attorney with McDermott Will & Emery who specializes in telemedicine, telehealth and mHealth, said providers don’t have a clear idea of what they can and can’t do.

“It’s creating an environment where healthcare providers are not wanting to do this at all,” she warned. “It has become too complicated.”That, says Davidsen, is why state lawmakers are stepping in.He says many states are working on databases that would help in online prescription drug monitoring programs, or PDMBs.“Simultaneously, some states also have continued to build, refine and expand statewide databases that store information regarding the prescriptions for controlled substances written by practitioners licensed by the state,” he wrote. “This information can help physicians and other prescribing health care providers to determine, if and when contemplating the issuance of a remote prescription to a certain patient, whether that patient may be ‘doctor shopping’ and/or whether concomitant medications may pose a risk to a patient if he/she is prescribed a particular drug. These databases, and the laws creating and amending them, may be one reason why states are more willing to expand remote prescribing practices given these new additional safeguards.”Davidsen, who calls the Ryan Haight Act “a good law,” says these PDMB efforts, and a willingness by state officials to include telemedicine and telehealth in rules defining the prescription of controlled substances, may be pushing the DEA to hold off on any action that would change the law.

“Perhaps the DEA’s response is a reaction to states that strongly oppose providing prescribing information to other states or even to the federal government for various reasons, including privacy concerns,” he wrote. “That is to say, perhaps states are more willing to loosen remote prescribing laws for controlled substances because the databases they control and the data provided thereunder have eased concerns with allowing prescribers to prescribe as they see fit based on the information available regardless of whether the prescriber is physically present in the same room as the patient.”In his conclusion, Davidsen advises healthcare practitioners to tread lightly on prescribing controlled substances via telehealth or telemedicine, since federal law would overrule state statues and leave doctors liable to prosecution and loss of DEA registratio.

“Healthcare providers contemplating the prescribing of any controlled substances through telehealth/telemedicine can benefit from doing diligence with the support of legal counsel to fully understand the potential impacts of Ryan Haight, relevant state laws, and the potential risk involved in such a venture before proceeding,” he wrote.